Triggers:

Check if  applicable

E4a – Wandering

E4b – Verbally abusive

E4c – Physically abusive

E4d – Socially inappropriate/disruptive

E4e – Resists care

E5 – Resident’s behavior status has deteriorated over the last 90 days

E5 – Behavior improved

Evaluate:

B5               Delirium

C1               Hearing problem

C4, 6           Communication deficit

D1               Visual problem

E1                Sad or anxious mood

F2                Unsettled relationship

F3c              Change in normal routines

I1q, u          Alzheimer’s or other dementia

I1dd-gg       Psychiatric diagnosis

J1i               Pain

J5a, b          Onset of acute illness or worsening of chronic illness

O4a-d         Psychotropic use

P2               Behavior management program

P4c-e          Restraint

Proceed with care-planning

Do not proceed with care-planning

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